Does the Psychiatric Diagnosis Process Qualify as a Degradation Ceremony?

By Michael Cornwall, PhD
Sociologist Harold Garfinkel, in his landmark article “Conditions For a Successful Degradation Ceremony” wrote that “Degradation ceremonies are those concerned with the alteration of total identities.”

I first read this liberating article in the 1970’s as I was trying to piece together my life after a lengthy experience of madness. It validated my gut-level belief that my avoidance of psychiatric treatment, no matter how much I was suffering, was necessary to avoid having my identity stripped from me and a new identity of life-long mental patient embedded in my psyche.

Garfinkel was greatly influenced by Erving Goffman, the father of Labeling Theory. Goffmans’s book “Asylums: Essays on the Social Situation of Mental Patients and Other Inmates” looked at how society deals with deviance by codifying and enforcing social roles and identities

But Garfinkel’s work on what he called “Status Degradation Ceremonies,” is very appropriately geared to help uncover more understanding about the impact of the process of psychiatric diagnosis.

Because I believe that undergoing a psychiatric diagnosis process has an uncanny and sinister-feeling quality to it that comes from a deeper aversion than just forming a rational objection to being labeled and subjected to a DSM-5 category.

I think our deep aversion to being diagnosed comes from a fundamental reality; that psychiatry has been invested with the same power to perform identity degradation that has always resided in designated specialists. “It will be treated here as axiomatic that there is no society whose social structure does not provide in its routine features, the conditions of identity degradation.”- says Garfinkel.

When we are diagnosed, we feel the weight of an ancient social sanction of identity degradation, one that has taken many forms from our tribal beginnings, but is still life-transforming in its power – even when carried out now with the best intentions, and for our perceived benefit by mental health professionals.

Garfinkel points to this almost archetypal human experience when he writes “Just as the structural conditions of shame are universal to all societies, by the very fact of their being organized, so the structural conditions of status degradation are universal to all societies.”

The crushing loss of faith in a happy future is profoundly damaging because of the loss of our personal sovereign identity, a rupture occurs in the personal continuity of who we were before we were diagnosed, with who we are said to now be.

Garfinkel asks “What program of communicative tactics will get the work of status degradation done?” A ceremony is required that will secure the “product of successful degradation work to be a changed total identity.

A professionally rendered DSM-5 Axis 1 diagnosis always rests on the belief that a bio-genetic disease process has been established to exist. The diagnosed person is informed that their illness should be of primary concern indefinitely, if not for the rest of their lives. From that fateful day of diagnosis forward, the person shall now be officially identified as someone with a major mental illness.

For Garfinkel, the person undergoing a status degradation process also “Must be placed outside, must be made strange” – and must become – “Literally a new and different person… the former identity stands as accidental; the new identity is the ‘basic reality.’” What the person is now is what they were “all along.”

But I learned there is a way out of this trap, there is good news. As so many readers of Madinamerica.com can testify, we can “render” all degradation ceremonies “useless.”

When I read the last line of Garfinkel’s article almost 40 years ago it felt like a jail-break to me, because it said I could – with a very simple move – render useless any attempt to pigeon-hole me and take away my identity via a psychiatric diagnosis.

I could simply choose to not acknowledge or honor the socially-sanctioned power of psychiatry to perform a degradation ceremony on me.

Because unless we volunteer to give that power to another person or our society, they can’t wield it.

Oh yes, they can diagnose us, lock us up and do all the human rights abuses they do that they call treatment, but if we refuse to give away our identity, no one can take it from us.

If the social institution of psychiatry is tasked by our society to regulate deviance via the identity degradation ceremony of diagnosis and oppressive “treatments” that are often human rights abuses, then how can such a dysfunctional, dystopian society find its way out of such a spiritually and morally bankrupt cultural dead end?

Can Garfinkel’s baleful pronouncement that all societies inherently are set up to have identity degradation ceremonies take place be flipped, and we claim that our society can and must also be a constant source of an opposite kind of ceremony that we pursue doing status elevation ceremonies, identity valuation ceremonies?

As individuals, we can refuse to give psychiatry the credence or moral authority to perform a successful identity degradation ceremony on us.

But how can our individual defiance reverse the ubiquitous practice of diagnosis/identity degradation?

Briefly, I will just say, as I approach 70 years in our Orwellian dreamscape, that I don’t look to social institutions like the law, religion, academia, political ideologies, or the media to save us from the societal dead end cul-de-sac we inhabit.

The collective horsepower to take back our culture from its blind masters resides right here on Madinamerica and on every psych ward and in every prison yard.

That transformative social power was present in the anti-war and social protest movement of the 1960’s, and the recent Occupy movement, the civil and women’s rights and LBGT movements, and our mad pride/consumer/survivor/ peer/recovery/human rights movement.

Our ceremonies of self-love and love for each other as comrades, and the ceremonies of open defiance we practice together, don’t mean the tragic fruits of rampant anarchy will replace the identity degradation ceremonies and human rights abuses that are masked by medical legitimacy.

Revolution is the word and the answer and it always has been. It is the sure path to personal and societal freedom and transformation. If we listen to our hearts and not so much to our heads, the right direction will keep being shown to us of how to proceed.

Imagine a society where one day psychiatric diagnosis and identity degradation ceremonies don’t happen any more. Like John Lennon sang – It’s easy if you try.